High preoperative expectations and postoperative fulfillment of expectations two years after decompression alone and decompression plus fusion for lumbar degenerative spondylolisthesis

Duculan, Roland; Fong, Alex; Cammisa, Frank P.; Sama, Andrew A.; Hughes, Alexander P.; Lebl, Darren R.; Mancuso, Carol A.; Girardi, Federico P.

doi:10.1016/j.spinee.2023.01.006

Cited by 11 publications

(10 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We retrospectively analyzed prospectively recruited patients undergoing operative treatment for DLS at a tertiary orthopedic center. Patients were drawn from a larger study, described in previous studies 18,19 . The operative treatment of DLS was classified as either DA or DF.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Decision-making Algorithm for the Surgical Treatment of Degenerative Lumbar Spondylolisthesis of L4/L5

Schönnagel

Caffard

Zhu

et al. 2023

Spine

Self Cite

View full text Add to dashboard Cite

Study Design. A retrospective analysis of prospectively collected data. Objective. To report the decision-making process for decompression alone (DA) and decompression and fusion (DF) at a tertiary orthopedic center and compare the operative outcomes between both groups. Background. Controversy exists around the optimal operative treatment for DLS, either with DF or DA. Although previous studies tried to establish specific indications, clinical decision-making algorithms are needed. Materials and Methods. Patients undergoing spinal surgery for DLS at L4/5 were retrospectively analyzed. A survey of spine surgeons was performed to identify factors influencing surgical decision-making, and their association with the surgical procedure was tested in the clinical data set. We then developed a clinical score based on the statistical analysis and survey results. The predictive capability of the score was tested in the clinical data set with a receiver operating characteristic (ROC) analysis. To evaluate the clinical outcome, two years follow-up postoperative Oswestry Disability Index (ODI), postoperative low back pain (LBP) (Numeric Analog Scale), and patient satisfaction were compared between the DF and DA groups. Results. A total of 124 patients were included in the analysis; 66 received DF (53.2%) and 58 DA (46.8%). Both groups showed no significant differences in postoperative ODI, LBP, or satisfaction. The degree of spondylolisthesis, facet joint diastasis and effusion, sagittal disbalance, and severity of LBP were identified as the most important factors for deciding on DA or DF. The area under the curve of the decision-making score was 0.84. At a cutoff of three points indicating DF, the accuracy was 80.6%. Conclusions. The two-year follow-up data showed that both groups showed similar improvement in ODI after both procedures, validating the respective decision. The developed score shows excellent predictive capabilities for the decision processes of different spine surgeons at a single tertiary center and highlights relevant clinical and radiographic parameters. Further studies are needed to assess the external applicability of these findings.

show abstract

Section: Methodsmentioning

confidence: 99%

“…Patients were drawn from a larger study, described in previous studies. 18,19 The operative treatment of DLS was classified as either DA or DF. Decompression encompassed discectomy, laminectomy, or partial vertebrectomy.…”

Section: Patient Populationmentioning

confidence: 99%

Decision-making Algorithm for the Surgical Treatment of Degenerative Lumbar Spondylolisthesis of L4/L5

Schönnagel

Caffard

Zhu

et al. 2023

Spine

Self Cite

View full text Add to dashboard Cite

show abstract

“…We retrospectively analyzed prospectively enrolled patients with DLS undergoing spinal surgery. Patients were drawn from a larger study, described in previous studies, 7,10 and were enrolled between January 2016 and December 2018. Patients of the 4 attending spine surgeons of this study (A.S., F.C., F.G. or A.H.) with DLS were recruited.…”

Section: Patient Populationmentioning

confidence: 99%

Association of abdominal aortic calcification and lower back pain in patients with degenerative spondylolisthesis

Schönnagel,

Muellner,

Suwalski

et al. 2023

Pain

Self Cite

View full text Add to dashboard Cite

Abdominal aortic calcification (AAC) is hypothesized to lead to ischemic pain of the lower back. This retrospective study aims to identify the relationship between AAC and lower back pain (LBP) in patients with degenerative lumbar spondylolisthesis. Lower back pain was assessed preoperatively and 2 years after surgery using the numeric analogue scale. Abdominal aortic calcification was assessed according to the Kauppila classification and was grouped into no, moderate, and severe. A multivariable regression, adjusted for age, sex, body mass index, hypertension, and smoking status, was used to assess the association between AAC and preoperative/postoperative LBP as well as change in LBP after surgery. A total of 262 patients were included in the final analysis. The multivariable logistic regression demonstrated an increased odds ratio (OR) for preoperative LBP ≥ 4 numeric analogue scale (OR = 9.49, 95% confidence interval [CI]: 2.71-40.59, P < 0.001) and postoperative LBP ≥ 4 (OR = 1.72, 95% CI: 0.92-3.21, P = 0.008) in patients with severe AAC compared with patients with no AAC. Both moderate and severe AAC were associated with reduced improvement in LBP after surgery (moderate AAC: OR = 0.44, 95% CI: 0.22-0.85, P = 0.016; severe AAC: OR = 0.41, 95% CI: 0.2-0.82, P = 0.012). This study demonstrates an independent association between AAC and LBP and reduced improvement after surgery. Evaluation of AAC could play a role in patient education and might be considered part of the differential diagnosis for LBP, although further prospective studies are needed.

show abstract

“…We retrospectively analyzed a cohort of patients diagnosed with degenerative spondylolisthesis who underwent decompression or decompression and fusion surgery in a tertiary orthopedic institution between 2016 and 2018, patients were drawn from a larger study, described in previous studies. 21,22 Decompression encompassed discectomy or laminectomy. Fusion patients included posterior and anterior interbody fusion as well as lateral fusion.…”

Section: Patient Populationmentioning

confidence: 99%

Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis

Camino-Willhuber,

Schönnagel,

Caffard

et al. 2023

Clinical Spine Surgery: A Spine Publication

Self Cite

View full text Add to dashboard Cite

Study Design: Retrospective study of prospective collected data. Objective: To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis. Summary of Background Data: IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed. Methods: We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis. Results: A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62–72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12–2.60), P=0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04–3.76), P=0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02–1.35), P=0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery. Conclusion: Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.

show abstract

High preoperative expectations and postoperative fulfillment of expectations two years after decompression alone and decompression plus fusion for lumbar degenerative spondylolisthesis

Cited by 11 publications

References 35 publications

Decision-making Algorithm for the Surgical Treatment of Degenerative Lumbar Spondylolisthesis of L4/L5

Decision-making Algorithm for the Surgical Treatment of Degenerative Lumbar Spondylolisthesis of L4/L5

Association of abdominal aortic calcification and lower back pain in patients with degenerative spondylolisthesis

Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis

Contact Info

Product

Resources

About